How do I treat and avoid constipation in toddlers?

Hi, I'm not a health professional but I am a mother and my son who is almost 2 went through a stage of this a few months ago.

In detail, this is how I resolved the situation - I gave him coloxyl syrup (which is a stool softener that you can buy at any pharmacy) in his morning bottle (he still loves his milk!) for 2 days to soften the poo so that he stopped being uncomfortable when trying to poo and therefor holding on as they were too hard. You may be able to give coloxyl for longer but check and I deffinitely wouldn't make a habit of using it. My son's paediatrician said Duphalac is a better option that coloxyl as it is a more natural product but I found it didn't soften the poo so I decided to use the stool softner first. 

Once the poo was not hard, I straight away went onto the below maintenance plan and have never had another problem since:

 - everyday I add a teaspoon of probiotics,  which are healthy gut flora into his evening bottle - Inner Health Plus powder - which you can buy from the pharmacy from the fridge. If she is on antibiotics for whatever reason you need to leave 11/2 - 2 hours between giving the anti and the probiotic otherwise the anti will just destroy the good bacteria in the probiotic.
 - I make sure he has either an apple or pear (sometimes 2) everyday which seems to keep him nice and regular and most importantly the poo soft.
 - I offer LOTS of water. I find the more water he drinks, the better and more regular he is. I have told daycare to also offer lots of water on the days he is there throughout the day which I know they do.
 - I found a great prune spread made by Bonvit from a health food store which I give him on toast for breakfast every 2 or 3 days. It tastes very yummy as it is sweet. This also helps keep poo soft and regular.
 - He mostly ate wholemeal bread anyway but my husband started to buy pita bread and some other white breads which my son was having. He is no longer eating any white bread at all.
 - My little one LOVES bananas but I found out they are very constipating in some children so he may get one a week.

All these steps have helped us greatly and he now poos daily and the vicious cycle has stopped!

I really hope this helps you :)

Hi Anonymous,
Thanks for your detailed response. It's great to get tips from another Mum. Love your ideas about the apple and prune spread. I was advised by my GP to give my daughter pureed prunes with yoghurt, however I found the consistency and taste so aweful that I felt it I couldn't eat it, there was no way my daughter would! Prune spread sounds like a much better option :-)
I agree with your view on the banana. I have made the mistake of too many bananas before, I paid the price!
Cheers, Sharon

No problem Sharon. The maintenance stuff definitely works BUT the key thing is that you have to start by making it comfortable for her to poo first and to do this I have found you need to use some form of laxative. For us the coloxyl did the trick as it was the hard, constipated poo that was causing the discomfort and him to hold on.

The other thing I do is buy prunes from Woolies or Coles (the preservative free ones in a pink packet) and chop them up into pieces as a snack for when we are out and about. I mix them into a little tupperware with cut up grapes. My little one loves this as both are sweet. Now he always ask for poons and brapes :)

I absolutely swear by the probiotics as well!! They are about $30 or $40 for the big bottle but as you only add a teaspoon a day it lasts for ages! 

Without knowing your little ones' dietary habits it's difficult to determine if the constipation is dietary related. Most of the time constipation is a direct result of a diet low in dietary fibre (a natural substance found in plant based foods, such as fruit, vegetables and breads/cereals).

To ensure a 2 year old toddler is getting enough dietary fibre, as well as a healthy balanced diet, their diet should be made up of the 5 core food groups:

1. Breads, Cereals, Rice/Pasta
At least 2 serves per day (1 serve = 2 slices of bread, 2 weet-bix, 1 cup porridge or cereal etc)

Note: wholemeal and wholegrain breads and cereals have more dietary fibre than the white varieties.

2. Vegetables
Aim for at least 1 serve per day (1 serve = 1 cup salad or 1/2 cup cooked vegetables etc)
 
3. Fruit
Aim for at least 1 serve per day (1 serve = 1 medium sized fruit (apple, banana, pear, peach, orange etc), 1 cup fruit salad etc)

Note: To increase fibre, keep the skins on where possible. Whole fruits are always better than consuming fruit juice.

4. Dairy or Dairy Alternatives
Aim for at least 1.5 serves per day

5. Protein/Meat sources
Aim for at least 1/2 serve per day

Some children also need the assistance of fibre supplements, which can be found from your local pharmacy or supermarket (movicol, metamucil, benefibre etc).

What is constipation?
Infants that strain or groan when they have a bowel movement are not constipated if their stool is soft, even if they only have a bowel movement every two or three days. It is also important to remember that many breastfed infants only have a bowel movement once every week or two.
 
How does it come about?
One of the things that is frustrating for parents is trying to understand why their child is constipated. Although many parents understand the role that too much cow's milk, a diet low in fiber and not drinking enough fluids have in contributing to constipation, they may have other children with the same diet who aren't constipated.

Part of the reason for this may be in your child's specific dietary needs. While he may drink an average amount of milk that isn't constipating for most children, it may be ‘too much’ for him.
In addition to your child's diet, the other main factor that contributes to constipation is having infrequent bowel movements. This often occurs after a child has had a large, hard and painful bowel movement, which can occasionally occur in anyone.

After this, because he may associate having a bowel movement with pain, he will try to hold his stools. This creates a vicious cycle, where bowel movements are painful, so he holds them in, causing his stools to be even larger and harder, which causes more pain when it finally does pass. Many parents mistake the behaviors that children develop to hold in stool as straining to have a bowel movement, but they are usually stiffening their muscles or fidgeting as an attempt to hold their stool in and avoid a painful bowel movement. 

TREATMENT PLAN
After you have tried to increase fluids (to drink at least 800mL/day) and fibre (age + 5g fibre daily) and you don't get the results you wanted, talk to your doctor about an appropriate laxative to help for the short term. DO NOT WEAN the meds without the guidance of a health care professional.

Constipation at this age is quite common, and the dietary issues have been well covered already. Lots of fibre and water and avoid constipating foods such as banana and rice cereal.

If the constipation is more severe, usually the first step is a stool softener and/or lubricant. There are a few options here:

- paraffin oil (eg Parachoc) acts as both a stool softener and a lubricant at the same time. It is not absorbed into the body but stays in the gut which means that it does not accumulate in the body. Tastes OK, comes in strawberry and chocolate preparations. Main problem is that it cannot be easily combined with anything else. In large doses it can cause leakage and soiling into underpants of liquid stool.

- lactulose (eg Actilax) is primarily a stool softener. This is actually a non-absorbed sugar which stays in the gut and passes through, drawing water into the gut to soften the contents. (This is an osmotic effect.) Tastes a bit like honey, can be dissolved in any watery liquid. Some children seem to become a bit “gassy” on large doses of it.

- Movicol (or Movicol-Half for children): another osmotic stool softener which comes in sachets which need to be dissolved in water. Good for older children as larger doses can be given, fairly tasteless.

- coloxyl (docusate sodium): This is one of the few medications which is safe in infants. It is a stool softener also works by drawing water into the gut. Comes as both tablets and liquid, the liquid is the easiest to give babies as it comes with a small dropper.

- senna (often combined with coloxyl): This is a gut stimulant, which means that it works by increasing the contractions of the colon to expel the stool. I do not usually recommend this for a few reasons. Most children have hard stool, not insufficient gut contractions. Forcing the gut to “push harder” when there is hard stool present can be painful and is not usually effective unless combined with some other agent. Also, gut stimulants can be dependency-creating which makes them unsuitable for long term use in children.

- enemas and suppositories: I do not usually recommend these in children at all. They are usually traumatic to administer and are not effective for long term constipation, as they tend to only effect the lowest part of the colon. Oral medication is much more effective for clearing out the whole intestine.

In general, the constipation often takes as long to resolve as it did to occur. If your child has been constipated for several months, it may mean medication for several months in order for the gut to recover. The child also needs to “learn” that passing stool can be pain-free in order to change from the holding-on behaviour that has been created by the assocation of fear and pain. Many parents are concerned about the use of laxative medications in children, but the ones listed above are safe for use for months. In my opinion, it is better to treat the constipation fully and completely and then wean off laxative medication than to reduce the medications too soon and have the child relapse. Managing constipation is also important for toilet training, and ideally the child should be treated before toilet training starts.

This is a very helpful overview of the issue, from the Royal Children's Hospital in Melbourne:  http://www.rch.org.au/kidsinfo/fact_sheets/Constipation/

give him more rightful fruit

Major headache here ppl. I also faced the same problem with my LO since last month. The constipation prob is frequent lehh, even when I feed so much water also cant seem to solve it entirely one la. Anyone has better constipation children treatment???? 

Although my child is 4 years old now, but i will still avoid too much solid food intake for her.. and definately no fried foods for her at young age.. and fruits are really good for health.. try papaya or bananas tat cut into small pieces. 

I have tried to give more fruits and vege to my DD, but still constipation will happen on her. OMG!!! So, better to seek for proper remedy or doctor advise. I think it might be useful. =) 

Based on my experience with Mamil, I think it's suitable for ur case la. Bcos Mamil is really good helping to preventing constipation for children with their highest level of DHA and no sucrose at all which is important ingredients in children constipation prevention. I used it and it's good, so i think it works for u as well.. Try and see for a week la, u will have immediate results. 

I rarely hear ppl saying that Mamil is good. well i mean in my circle of friends and network, often i hear about Friso and Sustagen. 

IMO, parents nowadays only care alot on the child's growth and not caring about other issues like eg children constipation. Thats why they mainly focus on the formulas that only help in child's growth and developement and miss out ingredients that help in constipation prevention in children. Thats why Mamil is not so popular but if u really do the comparison and all, u will knw how Mamil can help in constipation prevention in children.. 

I've tried Mamil and i find it not as good as Enfamil Enfagrow. Bcos Enfamil Enfagrow is natural milk powder and we as parent dont want so much chemical substance intake into our precious LO.. 

prune juice works great for my baby. You can try it out.

thanks for sharing~~~~~

My son DS (dear son) is 13 months old and had severe constipation. I tried prune but he was still having hard time pooping. Now he is getting Toddler magic tea with his formula and goes everyday without struggling.